Wang Jinmeng, Wu Wenfeng, Wu Huiyi
Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Pharmacy Department, Shandong First Medical University Affiliated People's Hospital, Jinan, China.
Front Immunol. 2025 Apr 15;16:1561638. doi: 10.3389/fimmu.2025.1561638. eCollection 2025.
Membranous nephropathy (MN) is a common cause of nephrotic syndrome (NS) in adults. Without treatment, two-thirds of patients with MN develop nonprogressive chronic kidney disease or end-stage renal disease within 10 years. Obinutuzumab (OBZ), which binds to CD20 and leads to a pronounced depletion of B cells, may elicit a better therapeutic response in patients with refractory MN who do not respond to rituximab or who have recurrent episodes.
We describe two MN patients, one positive and one negative for the M-type phospholipase A receptor antibody (PLAR Ab). Both patients had poor responses to rituximab, but had different responses to OBZ.
The patient positive for PLAR Ab had an immunologic response, and the patient negative for PLAR Ab had a nearcomplete clinical response.
OBZ appears to be a suitable alternative when other treatment options are ineffective or contraindicated. The efficacy of OBZ for treatment of refractory MN needs to be verified by large-scale multicenter clinical trials.
膜性肾病（MN）是成人肾病综合征（NS）的常见病因。未经治疗，三分之二的MN患者会在10年内发展为非进行性慢性肾脏病或终末期肾病。奥妥珠单抗（OBZ）可与CD20结合并导致B细胞显著耗竭，对于对利妥昔单抗无反应或有复发的难治性MN患者，可能会引发更好的治疗反应。
我们描述了两名MN患者，一名M型磷脂酶A受体抗体（PLAR Ab）阳性，一名PLAR Ab阴性。两名患者对利妥昔单抗反应均不佳，但对OBZ的反应不同。
PLAR Ab阳性患者出现免疫反应，PLAR Ab阴性患者有近乎完全的临床反应。
当其他治疗选择无效或禁忌时，OBZ似乎是一种合适的替代方案。OBZ治疗难治性MN的疗效需要通过大规模多中心临床试验来验证。
Zotero 插件